Abstract

Objective: To analyse the executive function(cognitive flexibility，shifting of attention, inhibitory control, plan ability)in patients with comorbiddepression and metabolic syndrome.To analyse the correlation of theexecutive function with the level of depression、anxiety and metabolicindicator.Methods: From April2013to December2013in physical examinationcenter, outpatient and inpatient department of the Mental Health Center ofSichuan Province,41patients meeting with the diagnostic criteria fordepression of the Chinese Classification and Diagnostic Criteria for MentalDisorders，Third Edition (CCMD-3) were selected;34patients meeting withthe diagnostic criteria for metabolic syndrome were selected;25patientsmeeting with the diagnostic criteria for depression of the ChineseClassification and Diagnostic Criteria for Mental Disorders，Third Edition(CCMD-3) and metabolic syndrome were selected;30normal control groupwere selected. A total of130cases were divided into depression group,metabolic syndrome group, comorbid group and normal control group. Thefour groups were measured and assessed with blood pressure, waist, HamiltonDepression Rating Scale, Hamilton Anxiety Scale, Wisconsin Card Sorting,Trail Making Test A and B, Tower of London and Stroop Color Word Test,and their venous blood were collected for triglyceride, high densitylipoprotein, fasting blood glucose, and OGTT two hour postprandial bloodglucose. Results:1.The total scores of HAMD, the scores of cognitive problem，retardation factor points, and hopelessness were different in the four groups，with statistical significance(P<0.05)，and the scores of comorbid group werethe highest, followed by depression group, again for metabolic syndromegroup and finally normal group. The scores of anxiety/somatization factor ofHAMD comorbid group was higher than depression group and metabolicsyndrome group, depression group and metabolic syndrome group was higherthan normal group(P<0.05). The scores of day and night factor of HAMD ofcomorbid group and depression group were higher than metabolic syndromegroup and normal group(P<0.05), and the scores of sleep disturbance factor ofcomorbid group were higher than depression group, depression group werehigher than metabolic syndrome group and normal group. And the scores ofweight factor had no statistical difference in four groups (P>0.05).The total scores of HAMA, the scores of mental anxiety were different infour groups, with statistical significance(P<0.05) and the scores of comorbidgroup，were the highest, followed by depression group, again for metabolicsyndrome group and finally normal group. The scores of somatic anxiety ofHAMA were different in four groups, with statistical significance(P<0.05)and the scores of somatic anxiety of comorbid group were higher thandepression group、metabolic syndrome group(P<0.05), and the scores ofsomatic anxiety of depression group and metabolic syndrome group werehigher than normal group（P<0.05）.2.The metabolic indicators were different in four groups，with statisticalsignificance(P<0.05).The level of waist circumference, systolic pressure,diastolic pressure, FPG, OGTT two hour postprandial blood glucose andtriglycerides of comorbid group, metabolic syndrome group was higher than depression group and normal group(P<0.05). The level of high densitylipoprotein of comorbid group, metabolic syndrome group was lower thandepression group and normal group (P<0.05).3. The total response numbers，perseverative error numbers，non-perseverative error numbers of WCST were different in four groups，withstatistical significance (P <0.05)，and comorbid group、depression group werehigher than metabolic syndrome group、normal group (P <0.05).There were no statistical differences in the completion time and errornumbers of Trail Making Test A in four groups(P>0.05). The completion timeand error numbers of Trail Making Test B were different in four groups，withstatistical significance（P<0.05），and comorbid group、depression groupwere higher than metabolic syndrome group、normal group(P <0.05).The completion time, error numbers and correct numbers of Tower ofLondon were different in four groups，with statistical significance（P <0.05）.The completion time and error numbers of comorbid group、depression groupand metabolic syndrome group were higher than normal group (P<0.05)，andthe correct numbers of comorbid group，depression group and metabolicsyndrome group were lower than normal group(P <0.05).There were no statistical differences in correct numbers and errornumbers of Stroop Color Word Test word and color in fourgroups(P>0.05).When word and color were different, the correct numbers ofStroop Color Word Test were different in four groups，with statisticalsignificance（P<0.05），and comorbid group、depression group were higherthan metabolic syndrome、normal group(P<0.05).4.The total response numbers of WCST of comorbid group were positively correlated with the total scores of HAMD, triglyceride and OGTTtwo hour postprandial blood glucose(r=0.40～0.43，P<0.05),but were notcorrelated with the total scores of HAMA and other metabolic indicator.WhenOGTT two hour postprandial blood glucose and TG controled，The totalresponses numbers of WCST were positively correlated with the total scoresof HAMD（r=0.46, P <0.05）.The completion time of Trail Making Test B of comorbid group were notcorrelated with the total scores of HAMD, the total scores of HAMA andmetabolic indicator(P>0.05).The completion time of Tower of London of comorbid group were notcorrelated with the total scores of HAMD, the total scores of HAMA andmetabolic indicator(P>0.05).When word and color were different,the correct numbers of StroopColor Word Test were negatively correlated with the total scores ofHAMD(r=-0.46,P<0.05),were not correlated with the total scores of HAMAand metabolic indicator(P>0.05).Conclusion:1.The patients with comorbid depression and metabolicsyndrome might have severer depressive and anxiety symptoms than thepatients with depression or metabolic syndrome.2.The executive function ofpatients with comorbid depression and metabolic syndrome, depression ormetabolic syndrome all were impaired, but had diffirent dimensions. Theexecutive function of patients with comorbid depression and metabolicsyndrome or depression were impaired mainly in cognitive flexibility，shiftingof attention, inhibitory control ability and plan ability. The executive functionof patients with metabolic syndrome were impaired mainly in plan ability.The plan ability of patients with comorbid depression and metabolic syndrome were not worse than the patients with depression or metabolicsyndrome.3.Probably the patients with comorbid depression and metabolicsyndrome had severer depressive symptoms, the cognitive flexibility andinhibitory control ability were worse.